Degenerative dystrophic changes in the spine. Degenerative-dystrophic changes in the lumbosacral spine

People of all ages suffer from problems, pathologies, and pain of the spine. Instability of the vertebrae, their displacement, and changes in structure most often cause pain and neurological disorders.

One of the many such diseases of the spine includes degenerative dystrophic changes in the lumbar region.

A number of factors contribute to the development of these changes in the spine: heavy workload, sedentary, sedentary lifestyle, excess weight.

Kinds

The most common cause of pain in the lumbar region is degenerative dystrophic disease of the spine (osteochondrosis, spondylosis, spondyloarthrosis). It is characterized by changes in vertebral tissues, transformations of intervertebral discs, joints, bone tissue, and ligaments.

Changes in intervertebral discs due to a complex of dystrophic disorders lead to osteochondrosis. Progressive deformation occurs - a decrease in the height of the disc, separation into parts, delamination.

The most common degenerative change is lumbar osteochondrosis. This is due to the heavy workload on this department. The aggravation and development of this problem is facilitated by:

spinal injuries (fractures, bruises);
overload;
predisposition;
age-related changes;
vibration and much more.

Due to the functional congestion of the segments of the spinal trunk, the lumbar region most often suffers.

People suffering from osteochondrosis complain of dull, aching pain in the lumbar region, muscle spasms, aches and numbness of the limbs.

Osteochondrosis of the lumbar region requires intensive, long-term, complex treatment.

Chronic disease of the spine, which is accompanied by degenerative dystrophic disorders of the fibrous tissue of the intervertebral discs and the formation of osteophytes, is called spondylosis.

Older people get sick more often. Spondylosis can develop in any part of the spinal trunk, but the lumbar part is most often affected.

Main reasons: static overloads, microtraumas, dynamic loads, metabolic disorders, age. The pain may be in the buttock, legs, thighs.

Possible limitation of mobility. Occurs when walking, vertical static load. The pain continues until the person bends forward.

Lumbar spondylosis progresses over a long period of time and is chronic.

Spondyloarthrosis is a degenerative disease of the facet joints of the spine. Impaired function of the facet joints leads to severe lower back pain.

It can develop independently, as well as simultaneously with osteochondrosis.

The causes may be congenital anomalies of the spine, trauma, chronic microtrauma of the spine. Most often, pain occurs during the transition from a state of rest to movement.

It worsens when bending and turning the body backwards. It is localized.

Causes

Degenerative changes can occur due to injury or during the natural aging process of the body.

The cause of degenerative dystrophic disorders of the lumbar spine is either inflammation or pathological instability of micromovements. Or both.

When an intervertebral hernia occurs, proteins in the disc space irritate the nerve roots.

And the fibrous ring loses strength and cannot withstand the load on the spine, which leads to great mobility in the affected area of the spine. All this together gives a huge constant pain in the back.

A complication of degenerative dystrophic changes is the formation of intervertebral hernia. When a disc herniation appears, mechanical compression of the neurovascular bundle also increases, as a result the pain intensifies and is permanent.

Symptoms

People who have degenerative changes in the lumbar region feel constant pain, which sometimes intensifies. Symptoms may appear as the processes progress. There can be many symptoms, but most often they are:

a feeling of discomfort during certain body movements (turning, bending, lifting weights);
numbness, tingling in the legs;
dull, aching pain in the lower back;
prolonged lumbar discomfort;
neurological disorders;
more discomfort when sitting than standing, walking or lying down.

Several stages of manifestation of degenerative-dystrophic changes can be distinguished:

The first stage, when a person has pronounced pain in the lower back. The discomfort is so great that a person has to limit his movements. Which makes it difficult to lead a normal life.

The second stage is characterized by limited mobility, lumbago, and tingling in the legs.

The next stage leads to poor circulation. Convulsions and numbness of the lower extremities appear.

And the most difficult stage, when paralysis or paresis occurs.

It is important to receive adequate therapy in a timely manner to avoid serious consequences.

Degenerative-dystrophic changes in sections of the spinal trunk predominantly develop as a result of chronic and acute overloads under the influence of all microtraumas.

With degenerative lesions, the vertebral bodies can move in different directions.

Treatment, diagnosis

When a patient consults a doctor with lower back pain, diagnosing such a disease is quite difficult, since it can be caused by many diseases.

Several methods are usually used:

X-ray examination.
CT scan.
Magnetic resonance imaging.
Comprehensive neurological examination.

It is undesirable to ignore pain in the lumbar region. This problem will not go away on its own. And self-medication can further worsen the condition. When prescribing treatment, the doctor must take into account all the characteristics of the patient’s body and make it comprehensive.

Treatment methods:

physiotherapeutic procedures;
drug treatment;
physiotherapy;
pool;
traditional methods;
acupuncture;
surgical treatment (rare cases);
massage.

This treatment relieves pain, strengthens the muscle corset, removes muscle tension, and increases blood supply to the spine.

At this point, it has become possible to deal with the cause of such problems. Taking into account the seriousness of the consequences, treatment and diagnosis should be carried out in a timely manner, as well as by qualified specialists.

Degenerative-dystrophic changes in the lumbosacral spine are the slow destruction of the tissues of the intervertebral discs of the lower back. They stop receiving nutrition, become dehydrated, become dry and lose elasticity. Excess weight and sedentary work lead to weakened back muscles and excess weight. As a result, the spine puts pressure on the intervertebral discs, and their structure becomes deformed.

Disc pathologies are dangerous because, as a rule, they can only be detected at critical moments. Preventive measures will no longer be able to help, and the patient will have to take medications and attend various medical procedures. But treatment alone may not be enough. After all, in order to improve the condition of the spine and prevent the development of serious complications, you need to reconsider your daily life as a whole.

What are degenerative-dystrophic changes in the lumbosacral region? To understand, let’s understand how intervertebral discs are structured. These peculiar springs of the spine consist of cartilage tissue. On top they are covered with a denser fibrous ring, and inside there is a nucleus pulposus. Discs are normally quite soft and elastic - after all, they ensure the mobility of the spine.

When the muscles can no longer withstand the load, they transfer it to the vertebrae. The spine is compressed, the discs experience pressure that they were not designed to withstand. The cells of their soft cartilage tissue begin to die.

Intervertebral discs can also weaken and become deformed because the nutrition of their cartilage tissue is impaired. This can happen due to the fact that the vertebrae reduce the distance between themselves and compress the blood vessels and capillaries. Or an inflammatory process or lower back injury led to the same consequences.

The risk factors are as follows:

Sudden movements, heavy lifting;
Inflammatory processes;
Sedentary work;
Cold and drafts;
Unhealthy food;
Professional sports;
Disturbed hormonal levels;
Elderly age;
Pathologies of metabolic processes;
Traumatic injuries of the vertebrae.

Most often, people who move very little and are overweight suffer from problems in the lumbar spine. Usually the spine stabilizes the muscles, but if the muscles are weakened and excess weight constantly burdens the back, even light household loads cause deformation of the discs. Modern lifestyle, as we see, increases the risk of developing dystrophic changes in the lumbar region.

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Progression of pathology

It is in the lumbosacral region that the lion's share of tension occurs; it is here that the intervertebral discs are most often deprived of the necessary nutrition. Cartilage tissue loses nutrients, regenerates worse, and ceases to be elastic.

The fibrous ring becomes fragile, the nucleus pulposus sharply loses moisture and dries out. As a rule, at the same time more and more loads are placed on the lower back, and the space between the vertebrae narrows even more. Excess tissue of the lumbar discs protrudes from the boundaries of the spinal column - this is called protrusion. And when the fibrous ring around the disc breaks its structure and ruptures, the result will be first the pulp coming out of the disc, and then the disc itself from its place in the spine. This is called a herniated lumbar spine.

Protrusions and hernias pinch, compress the nerves, and severe pain occurs. The body turns on the immune system to protect itself from the source of pain. As a result of this protection, inflammation and swelling form in the lumbar region, preventing the patient from living a normal life.

Degenerative-dystrophic changes in the lumbar spine develop unnoticed, and when it is too late to engage in prevention, they strike the patient. Even if you are lucky and no protrusion or hernia has formed, a person can suffer consequences such as osteochondrosis or radiculitis.

Symptoms

Unfortunately, until the lower back disease puts the patient’s performance at risk, the person is basically unaware of the disease. It is not the degenerative process itself that has symptoms, but its complications and consequences.

You should respond to the following sensations by visiting a neurologist or vertebrologist:

Stitching, burning or dull pain in the lower back;
The appearance of pain after exercise;
Pain after being in one position for a long time;
Difficulty performing certain movements, such as bending or turning;
Weakness in the legs;
Difficulty urinating, constipation;
Cold skin of the lumbar region;
Loss of mobility, especially in the morning;
Violation of body symmetry;
Swelling and red skin in the lumbar region.

There are four stages in the development of this pathology of the lumbosacral region:

At first, symptoms appear very rarely. True, often after physical activity people experience dull pain and stiffness in the lumbar region. But this is almost always attributed to fatigue;
In the second stage, symptoms appear. It is much more difficult to move the back; it is difficult for the patient to bend or turn. It “shoots” in the back, that is, radiculitis is talking about itself. Compressed nerves may cause tingling in the pelvis and legs. A feeling of “goosebumps” appears;
The third stage is acute. Blood vessels are pinched, the metabolism of the lower back muscles is sharply disrupted, which leads to their ischemia. The pain is getting worse. The legs go numb, they are pierced by cramps;
The fourth stage is diagnosed if the spinal cord and its nerve roots are deformed. This can cause your legs to become paralyzed.

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Diagnostics

Diagnosis of degenerative-dystrophic changes in the lumbosacral region is carried out in three stages:

A medical history is compiled, symptoms and usual conditions for the onset of a painful attack are indicated;
The doctor examines the patient for signs of tissue degeneration of the lumbosacral region - studies the level of mobility, muscle strength, areas of localization of pain;
An MRI is performed. She will find evidence that the patient is experiencing dystrophic changes in the lumbosacral region of the spine. Find physiological reasons that ultimately led to the development of pathology.

If a degenerative process in the lower back is indeed observed, then an MRI will certainly show that the symptoms are making themselves felt for one of the following reasons:

The intervertebral discs were deformed by more than half;
The discs are just beginning to deform, for example, the level of moisture in them is reduced;
The fibrous ring is already beginning to collapse, cartilage tissue cells are dying;
The annulus fibrosus is ruptured and the nucleus pulposus begins to leave the disc. That is, a hernia of the lumbosacral region has developed.

You may also need:

Blood tests;
X-ray examination;
CT scan.

However, an x-ray will not show signs of a pathological process at an early stage. CT scans and MRIs look much deeper into the spine. But unfortunately, these diagnostic methods are usually resorted to only when the problem has already made itself felt.

Many spinal pathologies have complex causes. For example, degenerative changes in the lumbosacral region arise as a result of prolonged exposure to various pathogenic factors, mainly related to the patient’s lifestyle and injuries incurred. Before you understand what vertebral bone dystrophy is and what it can entail, you should understand the features of the structure of the vertebra and what risks it is exposed to after damage.

As such, there is no diagnosis of degenerative-dystrophic changes in the lumbosacral spine. This phrase denotes a syndrome that is caused by traumatic influences, as well as internal processes occurring in the bone tissues of the body.

In most cases, the pathology develops gradually, and not as a result of a fracture, a severe blow (for example, damage in an accident) and is associated with a violation of metabolic processes in the tissues of the bones of the spine. Sometimes it can be provoked by hereditary factors, but most often the disease progresses due to the patient’s long-term poor lifestyle.

As a result, the structure of the intervertebral disc is disrupted. Normally, it consists of a nucleus pulposus, which is surrounded on all sides (circumference) by a fibrous membrane. When, due to an incorrect lifestyle and excessive pressure on the back, the vertebral bones, which are located above and below the disc, begin to shift relative to their normal position, they put pressure on the disc and gradually destroy its pulp and shell.

Thus, dystrophic changes in the lumbosacral spine are biochemical changes that lead to the destruction of the structure of the intervertebral disc, which negatively affects the functioning of the spinal column as a whole.

This name refers to a whole group of specific diagnoses:

osteochondrosis of different stages;
spondylosis;
spondyloarthrosis;
protrusion and intervertebral hernia.

The structural features of the intervertebral disc are such that it is restored through the division of its own cells, since it is deprived of blood supply. Accordingly, the nutrition of these tissues occurs differently. That is why, in most cases, degenerative-dystrophic changes occur rather slowly, over several years, without showing any signs.

When a syndrome of degenerative changes in the lumbosacral region is observed, it is quite difficult to establish one or more underlying causes. Therefore, they talk about specific causes that led to the disease, without analyzing what factors gave rise to these causes.

Usually these pathological changes lead to two reasons:

Inflammatory processes that occur due to the fact that the substance released from the dilapidated disc begins to come into contact with the nerve fibers (they are located in the spinal cord) and irritate them.
Increased mobility of the vertebral bones in the lumbar and other regions, which occurs due to the fact that the disc wears out, decreases in size and loses the ability to regulate correctly to hold the bones in space.

NOTE

Both of these reasons lead to impaired mobility of the vertebrae, and this leads to excessive mechanical friction of the bones and compression of the nerve fibers. Therefore, pain occurs in the corresponding department, and in advanced cases this can lead to serious complications, including paralysis of the lower extremities.

Other things being equal, the risk group includes people who have suffered a back injury and also lead an unhealthy lifestyle:

constant impact on the back due to heavy lifting (failure to comply with the load and rules for lifting loads);
active sports, risks of sports injuries;
sedentary lifestyle;
obesity - excess weight constantly puts pressure on the spine, having a negative impact on its integrity.

People over 60 years of age are also at risk, and women are more susceptible to the disease due to hormonal disruptions that occur after menopause.

PLEASE NOTE – The syndrome, in which degenerative-dystrophic changes in the lumbar or other parts of the spinal column are observed, is recorded in varying degrees of development in a third of people aged 30 to 50 years. In patients over 60 years of age, such pathologies are observed in more than 60% of cases.

Degenerative dystrophic changes in the lumbar region, as well as in the sacral spine, are not always characterized by the manifestation of any symptoms - for some time the disease may develop in a latent (hidden) stage.

As pathological processes develop, extraneous sensations arise, and then severe pain, as well as other symptoms:

Pain in the lower back, radiating to the buttocks, thighs and legs. It occurs irregularly and can be aching and sometimes sharp. At the same time, the pain in the lower back itself is in most cases dull, and it gives off with sharp blows.
Aching, very long-lasting pain in the lower back - they can last for several weeks, weakening slightly with the introduction of painkillers, and then intensifying again.
The initial signs of the syndrome are aching sensations that intensify during a sitting position, because it is at this moment that the lower back experiences increased stress (the discs are compressed). Also, extraneous sensations may arise from prolonged standing.
Transition of aching sensations into acute ones during simple, habitual movements: bending forward, turning the body. The pain becomes especially severe when lifting even small weights.
In more advanced cases, when intervertebral hernias form, the pain becomes pronounced, sharp, sometimes burning, and numbness, tingling, and coldness are often observed in different parts of the legs; severe fatigue when walking.
If the nerve fibers are compressed by the vertebrae, this is manifested not only by numbness in the legs, but also by pain - the corresponding pathology is called sciatica.
Symptoms from other organ systems are also observed in advanced cases of degenerative changes in the lumbar region: disorders of defecation and urination.
In rare cases, pain can extend along the entire back - this is due to the fact that changes in the spine lead to a general disruption of the functioning of nerve fibers that transmit pain sensations along their entire length.

The most common complications observed are stenosis (i.e., narrowing) of the spinal canal, as well as the formation of hernias and protrusions, which often require immediate surgical intervention. Such cases are the result of late seeking medical help.

IMPORTANT – If you experience constant bothersome pain or any other extraneous sensations (for example, a feeling of tightness in the lower back when standing for a long time), you should immediately consult a doctor, since in the early stages treatment is always carried out without surgery.

In almost all cases, degenerative changes in the lumbar spine are detected using complex diagnostics, in which, along with traditional methods, instrumental methods are used:

Analysis of the patient's complaints and medical history - it is especially important to take into account previous requests for help in situations where the patient has already undergone back surgery or courses of physiotherapeutic procedures.
External examination and identification of painful areas using palpation (palpation).
Carrying out an X-ray examination. As a rule, x-rays of the lower back are performed in two projections - straight and lateral. However, such a diagnosis may not reveal all dystrophic changes in the lumbar spine.
Very often, to obtain accurate information and correct diagnosis, magnetic resonance imaging (MRI) is used, which results in a so-called MRI picture of degenerative changes. It is characterized by a high degree of detail, thanks to which you can confidently determine the cause of the pathology, its degree and prescribe an effective course of treatment.

Typically, dystrophic change syndrome is diagnosed if the following MRI signs are observed:

the disc space (pulp and annulus fibrosus) is destroyed by more than half;
dehydration of the disc substance - in the picture the affected tissues appear darker due to lack of moisture;
external signs of destruction of the cartilage tissue of the end plate of the disc - externally observed as a black stripe in the corresponding place.
ruptures (complete or partial) and other violations of the integrity of the fibrous ring;
protrusion or intervertebral hernia - in this case, the pulp completely breaks through the fibrous ring, as a result of which the disc is destroyed, and its tissues come into contact with nerve fibers, provoking inflammatory processes.

Dystrophic changes are most often observed in the lumbar than in the sacral spine. The reason is that heavier loads are placed on the lower back. However, in cases where the patient is injured by falling on the tailbone, pathology begins to develop precisely in the sacral area.

In most cases, treatment does not involve surgery. The impact on vertebral tissue occurs chemically (with the help of medications), mechanical and electromagnetic.

Treatment with medications

Medicines in this case perform 2 important tasks - they relieve pain, and also promote tissue restoration by improving their nutrition. For these purposes the following are used:

muscle relaxants (relaxes the back muscles);
chondroprotectors (restore cartilage tissue);
sedatives and painkillers (to relieve pain and as sedatives for general relaxation of the patient);
B vitamins and mineral complexes are introduced so that the tissues receive additional nutrition and recover faster.

Medicines are administered both intravenously (injections, droppers) and externally (ointments, gels).

These procedures have the same goals as drug treatment, but affect the body differently (mechanically, using electric currents, electromagnetic fields, etc.). The following types of therapy are used:

electrophoresis;
magnetic therapy, etc.

The course of treatment is always prescribed individually and usually lasts several weeks.

Exercise therapy and spinal traction

This type of treatment for degenerative changes in different areas of the spine involves a mechanical effect on the spinal column as a whole in order to optimize the position of the bones relative to each other and stabilize their mobility. A special set of exercises is assumed, which is developed and performed under the supervision of a doctor. Home exercises are also acceptable, but only according to approved instructions.

Using self-medication in such cases may not only not give the desired effect, but also worsen the situation. The fact is that only a doctor can make a professional diagnosis and only after an instrumental examination. If you treat the wrong disease, you can only harm your back.

Disease prevention

Prevention of the development of degenerative diseases involves following natural, simple rules of a healthy lifestyle:

maintaining regular physical activity, including exercises to develop the spine (swimming helps a lot);
maintaining proper lifting technique;
avoiding situations of hypothermia of the lower back;
balanced diet: the daily menu should include not only calcium, but also substances that promote its absorption.

Prevention of the disease is much simpler than its treatment, so we can say that in most cases the health of a person’s back is in his own hands.

Degenerative-dystrophic changes in the spine are observed in 80% of the adult population of the planet. They worsen the quality of life and lead to the development of serious complications. How to avoid pathologies?

Take any person: everyone has suffered from lower back pain at least once in their life. Medical statistics say: 20% constantly complain of lumbar pain, and 1-3% require surgical treatment.

The lumbosacral region is the center of gravity of the body; it takes on all the loads accompanying any movement of the human body. Sometimes these loads exceed permissible limits, temporary changes and deformation of cartilage tissue occur in the spine. Under the influence of pressure on the damaged area of the spine, salts present in the bloodstream and plasma begin to actively penetrate into its structure. Calcification of a certain area of cartilage tissue begins. These are degenerative-dystrophic changes in the spine.

How do degenerative changes in the lumbar spine develop?

For degenerative changes to move into an irreversible phase, a lot of time must pass. And this time the disease plays out in a person, due to the fact that the disease does not manifest itself immediately.

Pronounced symptoms show themselves when time is lost, and the degenerative changes themselves have become large-scale and irreversible.

The medical term “degenerative-dystrophic changes in the spine” summarizes several diseases:

Degenerative-dystrophic changes in the lumbar spine: main symptoms

The clinical picture of changes may vary, depending on which spinal structures are damaged and how serious the damage is.

Symptoms of the disease appear as degenerative-dystrophic lesions develop, but in the initial stages they pass without pronounced external signs.

As the pathological process develops, the patient may feel stiffness and heaviness in the lower back. But, the main symptom of all degenerative changes in the spine is pain. Pain in the lumbar region occurs during long walking and physical activity, prolonged sitting in one position, and bending. The pain syndrome is wave-like: it arises, then decreases, and disappears.

The progressive degenerative process in the intervertebral discs of the spine can lead to serious and dangerous complications.

Degenerative changes develop in stages:

initial stage

The first symptom that “screams” about the presence of pathological changes in the lumbar spine is a pronounced pain syndrome in the lower back. The pain is so noticeable that the patient is forced to limit his movements, and this significantly reduces the normal standard of living and performance.

Complaints of pain directly depend on the location of the lesion.

Second stage of the disease

Further progression of degenerative changes is characterized by the presence of:

severe mobility limitations;
“lumbago” that occurs in the lower back;
tingling and goosebumps in the limbs and buttocks.

At the second stage of the disease, radicular syndrome develops - compression of the nerve roots occurs.

Third stage

At the third stage, blood circulation is disrupted due to compression of the radicular vessel, which leads to the development of ischemia. In addition to increasing pain, the third stage is noted:

partial or temporary numbness in the lower extremities;
convulsions.

Fourth stage

Degenerative pathological processes of the spine that have not received proper treatment at the fourth stage of development are fraught with paralysis and paresis. These complications arise due to complete disruption of the blood circulation of the spinal cord.

Causes of degenerative-dystrophic changes in the spine

The human body is a delicate and calibrated mechanism. It is determined by nature itself that the load on the human spine should be distributed evenly. A healthy spinal column can withstand both jumping and heavy lifting. But all this works only when a person watches his posture and has a strong muscle corset. Modern lifestyle is sedentary. And this leads to weakening of the muscle corset and weight gain.

Sedentary work contributes to the appearance of degenerative changes in the spine.

According to research, the human spine is in a bent position 75-80% of the time: the intervertebral discs become less elastic, and the vertebrae become deformed.

Due to degenerative changes, intervertebral discs lose moisture, cracks and all kinds of ruptures form in them. This contributes to the appearance of intervertebral hernias. When the load changes, the vertebrae try to increase their area, grow, and become increasingly thick, pinching the adjacent nerves.

Reasons that provoke pathological changes:

constant or sudden loads;
active sports with heavy loads;
injuries;
natural aging;
inflammatory diseases of the spine;
improper nutrition.

Treatment methods

Degenerative-dystrophic changes in the lumbar spine, alas, are observed in a large number of people, and therefore the question of how to treat these pathologies is very relevant.

After all, if degenerative changes are not treated, they will progress, and the consequences can be very dire, including disability due to impaired motor activity.

Treatment of diseases of the lumbar region is considered complete and promotes recovery if after treatment the following is observed:

reduction or disappearance of pain;
relieving muscle tension in the lumbar region, pelvis and lower extremities, strengthening muscles;
improvement of blood flow and supply of tissues with nutrients and oxygen, normalization of metabolic processes;
removal or reduction of inflammation;
normalization of lumbar sensitivity;

To achieve the above results, proper treatment is necessary. Specialists prescribe complex therapy using the latest achievements of modern medicine. For the treatment of degenerative changes in the lumbosacral spine, the following is prescribed:

drug therapy;
physiotherapy;
massage, therapeutic exercises, manual therapy;
acupuncture, acupuncture;
in extremely severe cases - surgical intervention.

Conclusion

From all of the above, it follows that diseases of the lumbosacral region can be overcome in several ways. But it is better not to allow irreversible pathological processes to occur. You should consult a doctor on time, monitor your health, and lead a correct lifestyle.

Causes of pathology

To understand the nature of the development of degenerative-dystrophic changes in intervertebral discs, it is very important to understand the reasons for the appearance of such processes. The fact is that the human body is a proven mechanism that can withstand colossal loads, but under the influence of various kinds of unfavorable factors, a weakening of the natural defense mechanisms is observed, which leads to a rapid breakdown of the integrity of cartilaginous structures. Modern lifestyle plays an important role in disrupting the trophism of intervertebral discs. Thus, the following triggers contribute to the development of degenerative changes in the spine:

sudden loads; inflammatory diseases; passive lifestyle; hypothermia; poor nutrition; active sports; hormonal disorders; diseases of the endocrine system; normal aging process; metabolic disorders; old and recent spinal injuries.

Most often, degenerative-dystrophic changes in the spine are observed in people who lead an extremely sedentary lifestyle and at the same time have an unhealthy diet. The fact is that normally the load on the spinal column is distributed evenly, and a developed muscular frame provides significant support to it. People who lead a sedentary lifestyle and have excess fat deposits, as a rule, have poorly developed muscles, so even the slightest strength exercises lead to serious overload of the intervertebral discs. In this case, the muscular frame can no longer take on part of the load during movement, which contributes to the rapid appearance of degenerative-dystrophic changes.

The influence of other unfavorable factors and their combinations also affects the condition of the spinal column, so in most cases it is extremely difficult to determine what exactly was the impetus for the appearance of such disorders in the cartilage tissue of the intervertebral discs. At the same time, understanding the cause of the appearance of such a pathological condition as degenerative-dystrophic changes in the spine allows us to take effective preventive measures.

Pathogenesis of disease development

It is now well known how degenerative-dystrophic changes in the lumbar spine develop. The spinal column in the sacrum and lower back bears the greatest load during any movement and even while sitting. Due to the influence of overloads, as well as other unfavorable factors, in the area of the intervertebral discs of this department, a disruption of the nutrition of cartilaginous tissue is primarily observed. There are no blood vessels directly in the intervertebral discs that could feed it directly, so often the first appearance of nutritional disturbances in the soft tissues surrounding the spinal column is observed. In the absence of the proper level of nutrition of the intervertebral discs, cartilage tissue begins to gradually deteriorate, losing elasticity.

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The second stage in the development of degenerative-dystrophic changes is the thinning and weakening of cartilage tissue. At this time, there is a gradual drying out of the cartilage, which leads to a slow decrease in the height of the intervertebral discs. Due to the destruction of the fibrous membrane, various protrusions, that is, disc protrusions, can occur. With critical destruction of the tissue of the fibrous ring, its rupture may occur, which in the vast majority of cases leads to the exit of the corpus pulposus beyond the intervertebral disc and the appearance of a hernial formation. Such protrusions inevitably entail changes in the proportions of the vertebrae and pinching of the nerve roots extending from the spinal cord.

In response to a violation of cartilage tissue, activation of the immune system is observed, the cat’s cells begin to produce prostaglandins, that is, substances that are inducers of the inflammatory process. Due to the production of these substances, there is an increase in blood supply and swelling of the soft tissues surrounding the spinal column, which is often accompanied by the appearance of even greater stiffness of the lumbar spine and pain in the affected area. Degenerative-dystrophic changes in the lumbosacral spine, as a rule, are characterized by slow progression and chronic course. In the future, dystrophic changes in the lumbar spine can become a springboard for the development of a number of dangerous diseases and complications, including osteochondrosis, radiculitis, etc.

Characteristic symptoms of the disease

In the vast majority of cases, patients cannot independently determine the onset of the development of degenerative-dystrophic changes, since at the initial stages of this pathological process there are usually no pronounced symptoms. In fact, there are 4 main stages of development of degenerative-dystrophic changes, each of which has its own characteristic features. At the initial stage, obvious symptoms that may indicate to a person without medical education that there are spinal problems may not be observed.

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However, often at this stage of the process severe dull pain in the lower back may occur after increased physical activity. In addition, some people report some stiffness in the lower back.

At the 2nd stage of the disease, severe symptoms may be observed. First of all, in people with this stage there is a serious restriction in the mobility of the spine; with any flexion, so-called “lumbago” may appear, that is, attacks of radiculitis. Patients may complain of tingling and pins and needles sensations in the buttocks and lower extremities.

At the 3rd stage of development of degenerative-dystrophic processes, the disease passes into the acute stage, since at this time there is compression of the radicular blood vessel and disruption of the nutrition of the soft tissues surrounding the spinal column, which leads to their ischemia. The physical manifestations of this stage include increasing pain, frequent cases of numbness of the lower extremities and cramps.

When degenerative-dystrophic processes of the spine enter stage 4, damage to the spinal cord and its branching roots may occur, which can lead to paresis and paralysis of the lower extremities. As a rule, such complications are a consequence of compression damage to the spinal cord or disruption of its nutrition.

Early diagnosis methods

In most cases, patients with degenerative-dystrophic processes in the lumbar spine come to the doctor in the later stages, when the symptoms manifest themselves quite intensely, preventing the person from leading a full daily life. Diagnosis of this pathological condition begins with a detailed analysis, examination of the lumbosacral spine and palpation.

As a rule, an external examination is not enough to assess the presence of pathological changes in the intervertebral discs and their extent. To confirm the diagnosis, a number of studies using modern medical equipment are required. Such studies include:

general blood analysis; radiography; computed tomography: magnetic resonance imaging.

Despite the fact that radiography is a publicly available diagnostic method, it is at the same time considered the least accurate and informative, since in the early stages of pathology development it does not allow identifying existing degenerative changes in the lumbosacral spine. CT and MRI are more reliable and modern imaging tools, so they can detect existing abnormalities even in the early stages. With MR, the picture allows us to notice the existing degenerative-dystrophic changes in the thoracic or lumbar spine, even if they are extremely weakly expressed. Thus, MRI is the most accurate modern diagnostic method.

How is therapy carried out?

Treatment of degenerative-dystrophic changes in the lumbar spine primarily involves the prescription of drug support to eliminate pain.

As a rule, injection blockades, ointments and creams with an analgesic effect are prescribed.

Drugs are prescribed to help restore blood supply, eliminate soft tissue swelling, improve cartilage trophism, and relieve muscle spasms. In addition, B vitamins are prescribed, which help reduce damage to nerve fibers during pinching and speed up its recovery. Common medications prescribed for the detection of degenerative changes include:

Diclofenac; Ketanov; Revmoxicam; Teraflex; Chondroitin; Mydocalm.

This is not a complete list of medications that can be used to identify degenerative processes. The picture of dystrophic changes in the lumbosacral spine largely influences the selection of medications in each final case. After eliminating acute symptomatic manifestations, a whole range of physiotherapeutic procedures and exercise therapy is prescribed. Physiotherapeutic procedures used for such spinal pathologies include magnetic therapy and electrophoresis. Acupuncture, acupuncture, therapeutic massage and other means are actively used.

Considering that the development of degenerative-dystrophic changes in the lumbosacral region is chronic, it is very important for the patient to take a responsible approach to exercise therapy. Therapeutic exercise allows you to develop the muscular framework and reduce the load on the spinal column, improve the nutrition of cartilage, preventing further degenerative changes in the spine.

The essence of pathology

This name refers to a whole group of specific diagnoses:

osteochondrosis of different stages; spondylosis; spondyloarthrosis; protrusion and intervertebral hernia.

Causes of the disease

Usually these pathological changes lead to two reasons:

Inflammatory processes that occur due to the fact that the substance released from the dilapidated disc begins to come into contact with the nerve fibers (they are located in the spinal cord) and irritate them. Increased mobility of the vertebral bones in the lumbar and other parts, which occurs due to the fact that the disc wears out, decreases in size and loses the ability to regulate properly to hold the bones in space.

NOTE

Risk group

Other things being equal, the risk group includes people who have suffered a back injury and also lead an unhealthy lifestyle:

constant impact on the back due to heavy lifting (failure to comply with the load and lifting rules); active sports, risks of sports injuries; sedentary lifestyle; obesity - excess weight constantly puts pressure on the spine, having a negative impact on its integrity.

People over 60 years of age are also at risk, and women are more susceptible to the disease due to hormonal disruptions that occur after menopause.

Symptoms of the disease

As pathological processes develop, extraneous sensations arise, and then severe pain, as well as other symptoms:

Pain in the lower back, radiating to the buttocks, thighs and legs. It occurs irregularly and can be aching and sometimes sharp. At the same time, in the lower back itself, the pain in most cases is dull, and it gives off in sharp blows. Aching, very long-lasting pain in the lower back - they can last for several weeks, weakening slightly with the introduction of painkillers, and then intensifying again. The initial signs of the syndrome are aching sensations , which intensify during a sitting position, because it is at this moment that the lower back experiences increased stress (the discs are compressed). Also, extraneous sensations can arise from standing for a long time. The transition of aching sensations into acute ones during simple, habitual movements: bending forward, turning the body. The pain becomes especially severe when lifting even small weights. In more advanced cases, when intervertebral hernias form, the pain acquires a pronounced sharp, sometimes burning character, and numbness, tingling, and coldness are often observed in different parts of the legs; severe fatigue when walking. If the nerve fibers are compressed by the vertebrae, this is manifested not only by numbness in the legs, but also by pain - the corresponding pathology is called sciatica. Symptoms from other organ systems are also observed in advanced cases of degenerative changes in the lumbar region: disorders of defecation and urination .In rare cases, pain can extend along the entire back - this is due to the fact that changes in the spine lead to a general disruption of the functioning of nerve fibers that transmit pain sensations along their entire length.

Diagnosis of pathology

In almost all cases, degenerative changes in the lumbar spine are detected using complex diagnostics, in which, along with traditional methods, instrumental methods are used:

Analysis of the patient's complaints and medical history - it is especially important to take into account previous requests for help in situations where the patient has already undergone back surgery or courses of physiotherapeutic procedures. External examination and identification of painful areas using palpation (palpation). Conducting an X-ray examination. As a rule, x-rays of the lower back are performed in two projections - straight and lateral. However, such a diagnosis may not reveal all dystrophic changes in the lumbar spine. Very often, magnetic resonance imaging (MRI) is used to obtain accurate information and correct diagnosis, which results in a so-called MRI picture of dystrophic changes. It is characterized by a high degree of detail, thanks to which you can confidently determine the cause of the pathology, its degree and prescribe an effective course of treatment.

Typically, dystrophic change syndrome is diagnosed if the following MRI signs are observed:

the disc space (pulp and annulus fibrosus) is destroyed by more than half; dehydration of the disc substance - in the picture the affected tissues appear darker due to lack of moisture; external signs of destruction of the cartilaginous tissue of the end plate of the disc - externally observed as a black stripe in the corresponding place. ruptures ( complete or partial) and other violations of the integrity of the fibrous ring; protrusion or intervertebral hernia - in this case, the pulp completely breaks through the fibrous ring, as a result of which the disc is destroyed, and its tissues come into contact with nerve fibers, provoking inflammatory processes.

Treatment

In most cases, treatment does not involve surgery. The impact on vertebral tissue occurs chemically (with the help of medications), mechanical and electromagnetic.

Treatment with medications

Medicines in this case perform 2 important tasks - they relieve pain, and also promote tissue restoration by improving their nutrition. For these purposes the following are used:

muscle relaxants (relax the back muscles); chondroprotectors (restore cartilage tissue); sedatives and painkillers (to relieve pain and as sedatives for general relaxation of the patient); B vitamins and mineral complexes are introduced so that the tissues receive additional nutrition and recover faster .

Medicines are administered both intravenously (injections, droppers) and externally (ointments, gels).

Physiotherapy and massage courses

electrophoresis; UHF; magnetic therapy, etc.

The course of treatment is always prescribed individually and usually lasts several weeks.

Exercise therapy and spinal traction

Disease prevention

Prevention of the development of degenerative diseases involves following the natural, simple rules of a healthy lifestyle: maintaining regular physical activity, including exercises for the development of the spine (swimming helps a lot); maintaining the correct technique for lifting weights; avoiding situations of hypothermia of the lower back; a balanced diet: part of the daily The menu should include not only calcium, but also substances that promote its absorption.

Prevention of the disease is much simpler than its treatment, so we can say that in most cases the health of a person’s back is in his own hands.

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Degenerative-dystrophic changes in the lumbosacral spine is a syndrome in which the pathology of the intervertebral disc provokes the appearance of lower back pain.

Although there is a slight genetic predisposition to the occurrence of this disease, the true cause of degenerative changes in the spine appears to be multifactorial in nature. Degenerative changes can be caused by the natural aging process of the body or have a traumatic nature. However, they are rarely the result of extensive trauma, such as a car accident. Most often, we will be talking about a slow traumatic process leading to damage to the intervertebral disc, which progresses over time.

The intervertebral disc itself does not have a blood supply, so if it is damaged, it cannot repair itself in the same way as other tissues in the body. Therefore, even minor damage to the disk can lead to the so-called. a “degenerative cascade” due to which the intervertebral disc begins to deteriorate. Despite the relative severity of the disease, it is very common, and current estimates suggest that at least 30% of people aged 30–50 years have some degree of disc space degeneration, although not all experience pain or are diagnosed with it. In fact, in patients over 60 years of age, some level of intervertebral disc degeneration detected by MRI is the rule rather than the exception.

Causes

Degenerative-dystrophic changes in the lumbosacral spine are usually provoked by one or both of the following two reasons:

Inflammation that occurs when proteins in the disc space, when a herniated disc forms, irritate the nerve roots. Pathological instability of micromotion, when the outer shell of the disc (annulus fibrosus) wears out and cannot effectively withstand the load on the spine, which leads to excessive mobility in the affected spinal segment.

The combination of both factors can lead to persistent lower back pain.

The combination of both factors is most common in the formation of intervertebral hernia, which is a complication of the degenerative process in the intervertebral discs. When a disc herniation occurs, mechanical compression of the neurovascular bundle passing in the spinal canal is also added, as a result of which the pain in the lower back increases significantly and becomes permanent.

Symptoms

Most patients with degenerative-dystrophic changes in the lumbosacral spine experience constant but tolerable pain, which intensifies from time to time for several days or more. Symptoms may vary depending on the individual case, but the main symptoms of this disease are as follows:

Pain localized in the lower back, which can radiate to the hips and legs; Long-lasting pain in the lower back (lasting more than 6 weeks); Low back pain is usually described as dull or aching, as opposed to a burning pain in the areas to which it radiates; The pain is usually worse in a sitting position, when the discs are subjected to more pronounced stress compared to what is placed on the spine when the patient stands, walks or lies down. Prolonged standing can also increase pain, as can bending forward and lifting objects; The pain worsens when performing certain movements, especially when bending, turning the body and lifting heavy objects; When a disc herniates, symptoms may include numbness and tingling in the legs and difficulty walking; With a medium or large disc herniation, the nerve root emerging from the spinal cord at the affected level may be compressed (foraminal stenosis), which, in turn, can lead to pain in the legs (sciatica); Neurological symptoms (for example, weakness in the lower extremities) or dysfunction of the pelvic organs (various urination and defecation disorders) may be a consequence of the development of cauda equina syndrome. Cauda equina syndrome requires immediate action to provide qualified medical care. In addition to lower back pain, the patient may also experience leg pain, numbness, or tingling. Even in the absence of compression of the nerve root, other vertebral structures can cause pain to radiate to the buttocks and legs. The nerves become more sensitive due to inflammation caused by proteins within the disc space, causing numbness and tingling sensations. Usually in such cases the pain does not go below the knee;

In addition to degenerative changes in the intervertebral discs, the cause of pain can be:

Stenosis (narrowing) of the spinal canal and/or osteoarthritis, as well as other progressive diseases of the spine, the occurrence of which is facilitated by degeneration of the intervertebral discs; Intervertebral hernia, a consequence of intervertebral disc degeneration.

Diagnostics

Diagnosis of the presence of degenerative-dystrophic changes in the lumbosacral spine is usually carried out in three steps:

Compiling a history of the patient, including when the pain began, a description of pain and other symptoms, as well as actions, positions and treatments (if treatment was carried out) that relieve or, conversely, increase pain; A medical examination during which the doctor checks the patient for signs of intervertebral disc degeneration. This examination may include checking the patient's range of motion, muscle strength, looking for painful areas, etc. MRI scanning, which is used to confirm suspicions of degenerative changes in the spine, as well as to identify other potential causes that led to the appearance of painful symptoms in the patient.

MRI results most likely indicating the presence of degenerative changes as the cause of pain symptoms:

Disk space is destroyed by more than 50%; Initial signs of disc space degeneration, such as disc dehydration (on MRI such a disc will appear darker because it will contain less water than a healthy disc); There are signs of erosion of the cartilaginous end plate of the vertebral body. The disc does not have its own blood supply system, but, nevertheless, living cells are located inside the disc space. These cells receive nutrition by diffusion through the end plate. Pathological changes in the end plate as a result of degeneration lead to disruption of cell nutrition. Such changes are best seen on T2-weighted images taken in the sagittal plane. Typically, the end plate appears as a black line on MRI. If this black line is not visible, it indicates endplate erosion. Rupture in the fibrous ring Presence of protrusion or intervertebral hernia

Treatment

The vast majority of cases of intervertebral disc degeneration do not require surgical intervention and are treated using conservative methods, which include special therapeutic exercises, physiotherapy, and various types of massages. In addition, spinal traction helps very well with disc degeneration, since it increases the distance between the vertebrae, allows the intervertebral disc to receive the water and nutrients it needs, which contributes to its recovery.

Non-stress spinal traction is ideal for the treatment of degenerative lesions of the intervertebral discs (spinal osteochondrosis) and its complications - spondylosis, spondyloarthrosis, intervertebral hernias and protrusions. Traction takes place while maintaining all the physiological curves of the spine and is safe, since no force is used during traction. As the intervertebral distance increases, the nutrition of all intervertebral discs improves, their structure is restored and pain is relieved.

With the help of complex treatment, it is possible to achieve a complete recovery of the patient, and not just pain relief for a limited period.

If you have pain, you can consult a neurologist at one of our Moscow Clinics. For citizens of the Russian Federation, consultation is free.

Article added to Yandex Webmaster 07/22/2014, 13:32

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We bring to your attention a classic article on this issue.

ON THE. Pozdeeva, V.A. Sorokovikov
GU NTs RVH VSNTs SB RAMS (Irkutsk)

Diagnosis of lumbar vertebral displacement is one of the least studied issues in radiology. Interest in this pathological condition of the spine is not accidental. Instability - displacement of the vertebrae - as one of the forms of dysfunction of the motor segment, becomes the cause of pain and subsequent neurological disorders. Taking into account the costs of diagnosis and treatment, as well as workers' compensation and disability, it can be argued that low back pain syndrome is the third most expensive disease after heart disease and cancer.

DEGENERATIVE-DYSTROPHIC CHANGES IN LUMBOSACRAL PART OF THE SPINE
(OCCURRENCE, CLINIC, PROPHYLAXIS)
N.A. Pozdeyeva, V.A. Sorokovikov
SC RRS ESSC SB RAMS, Irkutsk
Diagnostics of dislocation of lumbar vertebrae is one of the less studied issues of radiology. Interest in this pathological condition is not at all casual. Instability - vertebrae dislocation. - as one form, of the dysfunction of movement segment becomes a cause of pain syndrome and further coming neurological disorders. Taking into consideration expenses of diagnostics and treatment, and also of compensation of disablement of working patients, invalidity, we may assert that lumbar pain syndrome is the third, of the most “expensive” disease after coronary disorders and cancer.

Degenerative diseases of the spine are one of the leading social problems that have an important economic aspect, since this pathology most often affects young and middle-aged people, who make up the largest category of the working population. According to Holger Pettersson (1995), the diagnosis of these diseases is difficult, because there is a weak correlation between the results of X-ray examination and clinical symptoms.

Diagnosis of lumbar vertebral displacement is one of the least studied issues in radiology. Interest in this pathological condition of the spine is not accidental. Instability - displacement of the vertebrae - as one of the forms of dysfunction of the motor segment, becomes the cause of pain and subsequent neurological disorders. Taking into account the costs of diagnosis and treatment, as well as compensation for workers' incapacity and disability, it can be argued that low back pain syndrome is the third most expensive disease after cancer and heart disease.

The medical and socio-economic significance of the problem of diagnosis and treatment of osteochondrosis of the lumbar spine is due to a number of reasons. According to the World Health Organization (2003), spinal osteochondrosis affects 30 to 87% of the most able-bodied population aged 30 to 60 years. Spinal osteochondrosis accounts for 20 to 80% of cases of temporary disability. Incidence rates in Russia tend to increase, while in the vast majority of patients the disease is accompanied by damage to the lumbar spine. According to the VIII World Congress on Pain, which took place in Vancouver in 1996, back pain is the second most common reason for visiting a doctor and the third most common cause of hospitalization after respiratory diseases, while 60-80% of the population have experienced it at least one day. In the structure of morbidity among the adult population of our country, lumbar osteochondrosis accounts for 48–52%, ranking first, including in terms of the number of days of disability. Temporary disability in 40% of neurological diseases is caused by lumbar ischialgic syndromes. In the general structure of disability from diseases of the osteoarticular system, degenerative-dystrophic diseases of the spine account for 20.4%. The disability rate for degenerative spinal diseases is 0.4 per 10,000 inhabitants. Among disabled people with other diseases of the musculoskeletal system, this pathological condition ranks first in frequency of occurrence, and in 2/3 of patients the ability to work is completely lost.

Mobility of the spine is possible thanks to the complex interactions of the elastic apparatus of the vertebral bodies, arches and intervertebral discs. The functional unit of the spine at any level is the motion segment, a concept introduced by Iunghanus in 1930. The motion segment includes two adjacent vertebrae, the disc between them, the corresponding pair of intervertebral joints and the ligamentous apparatus at this level. At the level of any one segment, the mobility of the spine is relatively small, but the summed movements of the segments provide it generally within a wider range.

Research by L.B. Fialkova (1967), Buetti-Bauml (1964) and others show that in the lumbar region the most mobile segment in terms of flexion and extension in the frontal plane is the L4 - L5 segment; this explains its overload, leading to degenerative lesions and displacement of the vertebrae.

Intervertebral joints belong to the group of low-moving joints and are combined joints. The main functional purpose of the joints of the spine is the direction of movement, as well as limiting the range of movement within these directions.

Under normal static conditions, the articular processes do not bear vertical loads: the function of absorbing vertical pressure forces (the weight of the head, torso) is carried out by the intervertebral discs. In cases where the articular processes are forced to at least partially perform a supporting function that is not characteristic of them (with large static loads on the spine in combination with obesity), local arthrosis and anterior displacement of the vertebrae (antelisthesis) develop in the true joints, and with significant, ever-increasing vertical load - neoarthrosis of the articular processes with the bases of the arches.

The role of the disc in the statics of the spine is to absorb the pressure exerted on the spine by the weight of the body and physical activity. This means that the force acting on the intervertebral disc must be balanced by an equal but opposite force on the disc.

The applied force is resisted not only by the entire spine, but also by the muscular-ligamentous apparatus of the torso, which adapts to the external load. The most important forces are those acting in the plane of the disks, in other words, the traction forces transmitted to the disk. They can reach significant intensity and cause most mechanical damage to discs.

A particular form of spinal injury can be categorized as either a stable or unstable injury. The concept of “stable and unstable injuries” was introduced by Nicoll in 1949 for the lumbothoracic spine, and in 1963 by Holdsworth it was extended to the entire spine. According to this theory, disruption of the posterior structure is a necessary condition for spinal instability.

F. Denis (1982-1984) introduced the three-support concept of spinal instability - the “three columns” theory, with the anterior supporting structure consisting of: the anterior longitudinal ligament, the anterior part of the fibrous ring, the anterior half of the vertebral bodies; the middle supporting structure consists of: the posterior longitudinal ligament, the posterior part of the fibrous ring, the posterior half of the vertebral bodies and the posterior supporting structure includes: the supraspinous ligament, interspinous ligament, joint capsules, ligamentum flavum, vertebral arches. According to this theory, rupture of both the posterior and medial supporting structures is necessary for instability to occur.
Degenerative-dystrophic changes in spinal segments develop mainly as a result of acute and chronic overloads under the influence of cumulative microtraumas.
Intervertebral discs are highly durable and can withstand static loads that are applied slowly, such as carrying a heavy load. A dynamic, instantly applied load, creating impacts of high local force, as a rule, leads to varying degrees of compression of the vertebral bodies, and also causes damage to the discs. With disc lesions, when the nucleus pulposus loses its function as the axis of the ball joint, movements are reduced in volume or blocked, despite the integrity of the rest of the musculoskeletal and ligamentous apparatus.
The disc prevents not only the approaching, but also the moving away of the vertebral bodies. This function is provided by the collagen fibers of the plates of the fibrous ring, which is tightly fixed to the cartilaginous layer and in the peripheral portion of the limbus. In cases where the connection between them weakens, for example, with degenerative lesions in the spinal segments, the vertebral bodies, not being firmly connected to the discs, can shift in different directions.
The variety of emerging pathomorphological and pathophysiological situations also determines the clinical polymorphism of the disease. Anatomical formations of different structure and functions are involved in the pathological process.
The clinical manifestations of this process are dorsalgia - pain in the back (with possible irradiation to the limbs), which is caused by functional and dystrophic changes in the tissues of the musculoskeletal system (muscles, fascia, tendons, ligaments, joints, disc) with the possible involvement of adjacent structures of the peripheral nervous system (root, nerve).
In the pathogenesis of chronic dorsalgia, the leading role is played by decompensation of dystrophic changes in the tissues of the musculoskeletal system, as well as dysfunction of individual muscles and joints, which leads to the formation of sources of nociception with subsequent segmental and suprasegmental response.
In the mechanism of development of radiculopathy, compression of the root in a narrow “tunnel” plays a role, the walls of which can be formed by various structures: disc herniation, ligamentum flavum, tissues of the facet joint, osteophytes. Of great importance in this case is the disruption of the blood circulation of the root in the compression zone with subsequent swelling.
Risk factors for the development of pain syndromes of a musculoskeletal nature include:
o Motor imbalance (improper posture, scoliosis, decreased extensibility, strength and endurance of muscles, pathological motor stereotype);
o Spinal dysplasia;
o Constitutional hypermobility;
o Dystrophic changes in the musculoskeletal system.
They create the prerequisites for the development of functional disorders in various parts of the musculoskeletal system and the disruption of compensation of natural age-related degenerative processes under the influence of provoking factors.
The problem of instability of the spinal motion segment, which arises under the influence of various factors, is far from being resolved. First of all, this concerns the systematization of the most important pathogenetic mechanisms, taking into account the role of morpho-functional changes in spinal structures, biomechanics, as well as the need to diagnose SMS instability in the early stages of the degenerative process.

1. Galley R.L. Emergency orthopedics. Spine / R.L. Galley, D.W. Speight, R.R. Simon: Transl. from English - M.: Medicine, 1995. - 432 p.

2. Epifanov V.A. Osteochondrosis of the spine / V.A. Epifanov, I.S. Rollik, A.V. Epifanov. - M.: Medicine, 2000. - 344 p.